by Charlotte Brudenell, ACT-Caritas
It's Sunday, market day in Hassaballa. People have come to trade their wares, but they have also come to visit the mobile health clinic, which has been set up by ACT-Caritas.
Near the market, under a large acacia tree, a group of men, women and children are gathered, listening intently to Ibrahim Suliman Hajar, the mobile clinic's Sudanese supervisor.
"In the morning I give sessions to the community to educate them about health matters and hygiene," Ibrahim explains.
"And in the afternoon, we offer medical consultations, mother and child healthcare and give out the appropriate medicines to treat ailments."
The mobile clinic visits Hassaballa twice a week, providing medical services to a total population of more than 18,000 people in the area. "On average we see some 50 to 80 patients each time," says Ibrahim.
"This clinic is so important for the area. It is so great that people can come here and get treatment. The nearest clinic is more than a four hour journey away," says one local sheikh, Ahmed Fadil Omer, who is also head of the health committee for the clinic.
"The health education sessions are also important. Some diseases such as diarrhoea, malaria and tropical diseases like bilharzia (parasitic worms) are communicable, and health education can prevent these diseases from spreading. We have already noticed that they have decreased in our villages."
The health education sessions target the five most common conditions reported in the monthly mortality and morbidity data. "There is now a big difference in the health of the community thanks to health education," Ibrahim says.
"The benefits of providing a basic health service are immediate. But some things require a long time to change," says Dr Raymond Mutisya, health advisor for ACT-Caritas in Kubum.
"If you tell someone who smokes that it is bad for their health, they will say 'yes, I know that' but they don't stop. Here we are facing a lot of cultural beliefs which impact negatively upon the health of the population."
Khaltoum is 25 years old and is attending the clinic with her nine-month old daughter, Hanan. "I have abdominal pain, but I come here every week to attend the education sessions."
"Today the session talked about correct breastfeeding practices, mother and child hygiene, not to carry heavy items when pregnant, not to give water to children under six months old, and the importance of ante and post natal care."
When queried on whether she puts the lessons into practice, such as not carrying heavy loads when pregnant, Khaltoum admits laughingly: "I have to do this - no one else will do it for me. The water is nearby, but I have to go far to fetch firewood." In rural Darfur, getting water and wood is unquestionably women's work.
"The mobile clinic has done a good job. It is able to offer basic primary health care and disseminate health education," says Dr. Mutisya. "However, maintenance of such a service is not cost-effective."
The cost of vehicle maintenance, fuel, and paying drivers is high and is only sustainable in the short-term. The challenge now is how to ensure this service continues when ACT-Caritas is no longer there.
The State Ministry of Health simply doesn't have the human resources to staff even the current clinics, let alone new ones. So, ACT-Caritas is working with the local community on a range of solutions.
The first step has been to set up a health committee with representatives from the whole community: women, sheikhs, young people, local authorities and traditional community health workers.
The committee is then given training to understand their role, leadership skills, health promotion and provided with guidence on the management of the clinic, as well as fundraising aspects.
Self-provision of healthcare
The health committee has also been responsible for mobilising the community to build shelters in which the consultations take place, and encouraging people to attend the educational sessions.
It is now organising the construction of permanent buildings, and has arranged to charge patients (not including the very ill, children under five years old or pregnant mothers) a small fee for attending the clinic so as to raise money to pay for materials. In Sudan, it is government policy to charge patients a fee for the provision of healthcare.
"If there is a permanent structure, the community will be encouraged to continue health service provision by themselves, and they can even perhaps begin to negotiate with the Ministry of Health for assistance," says Dr Mutisya.
In the meantime, the major emphasis for ACT-Caritas is to develop the skills and knowledge of the health workers in the community - traditional healers and birth attendants.
Through training and mentoring, so as to build their capacity, it is hoped that the community workers will be able to continue to offer an effective basic health service when ACT-Caritas stops the mobile service.
The community midwifery workers have also been given equipment to enable them to support clean delivery, and monitor and supply prenatal care.
In addition, efforts are being made to empower health promoters within the community with the knowledge and skills they need to be able to continue to disseminate health messages beyond ACT-Caritas's project.
"Preventative medicine is superior to curative," explains Dr Mutisya. "Disseminating information targeting specific conditions provides a good chance of preventing or minimising the damage of an outbreak of disease."